Psychiatrists more vulnerable to burnout?

[carazadie]

Psychiatry is developing a reputation as a "lifestyle" specialty with fewer hours and a slower pace than many other medical fields. Yet, some studies have suggested that psychiatrists experienced higher rates of burnout than other physicians. The data is admittedly conflicting, as some recent surveys showed a higher job satisfaction among psychiatrists than other physicians, but other studies have shown higher rates of burnout, divorce, and suicide among psychiatrists.

 

I would be interested to hear from psych residents or practicing psychiatrists about your own experiences. Have you experienced burnout during your residency/practice? Is burnout a significant issue among your colleagues?

 

Thanks

[BigM]

I'm an incoming PGY1 psych resident, so I can't speak off of a great deal of experience but I can share some thoughts.

 

Burnout can certainly be an issue in psychiatry, as in all other medical fields. Patients using psychiatry services can be fairly dependent and demanding. However, from what I have seen, these are generally a minority of patients and your training should help you to deal with these issues. The work hours can be significantly less than other medical fields and the environment is generally supportive, these are both very strongly protective against burnout. Overall, I actually suspect that the burnout rate in psychiatry would be lower than other medical fields, but I don't feel like searching through literature right now to support that claim.

 

If you spend a significant amount of time working in mental health fields you will notice that many individuals working there have been personally affected by mental illness. Its not everyone, but a lot of people have either had first hand experience with mental illness or someone close to them (a family member?) has. This can be one of the things that motivate people to overcome the social stigma and pursue work in these fields. However, it can also unfortunately mean that some individuals are more prone to things like suicide and addiction.

 

The divorce aspect is something that I have seen in the past from a few studies. It's an unfortunate thing as psychiatrists are trained with many skills for conflict resolution and communication, but it can be harder to apply these in your own personal life than to use them with others.

[ellorie]

I hope that some people who are psychiatry trainees will chime in - but I wonder if stigma is a big part of it.

 

It's HARD to see your patients getting beaten down by society - when they are already sick and needing help. I've seen so many patients who had so little support, and who were getting taken advantage of left right and centre. I would say much more so on psychiatry compared to other rotations.

 

There isn't a great infrastructure or enough resources. I can imagine that would get hard.

[Renin]

I suppose I can only speak from my personal experience. There's work stressors and then there's personal stressors... I'll address one at a time.

 

Work stress is like what Ellorie alluded to. Sometimes we just don't have anything to give, but we're asked to provide things, and we want to. Sometimes we're asked for things, but we can't give them for a therapeutic good. Sometimes families or other professionals demand things and we can't give them for therapeutic good, but others do not understand. Doing psychoeducation at 2 am, despite your best efforts, sometimes does not go well. My colleagues are extremely supportive and the faculty and staff are amazing. This helps against burnout, but there's something very lonely when the other services aren't supportive and you are the person kind of fielding the work issues.

 

I can't get into details because it's a public forum (obviously), but some days, despite our "shorter work hours" you leave bagged. I haven't been physically assaulted, but I have been verbally threatened by patients and families. Security is always available for an escort to your car. I don't really get these "shorter hours" either - I send the medical students home a lot sooner than I personally go home to slog through paperwork, and make phone calls, obtain collateral, talk to patients, talk to family, talk to other service providers in hospital and out ... so maybe that's the perception we work fewer hours? As for the slower pace, don't forget that when we interview a patient for 45 minutes, we're getting a lot of information. You're not a walking and talking list of memorized questions. There are many nuances to the psychiatric interview and treatment. You're thinking all the time - it might look quiet. It's like the swan on the lake; it looks calm, but under the water they're paddling away like crazy!

 

There's a meme thing going around describing people's attitude towards mental illness vs. medical illness. I think someone who is having a heart attack is told to think happy thoughts or something. The degree of impairment between mild, moderate and severe mental illness is such a great scale that I don't think laypeople realize it. Also, a lot of people use mental health terms as descriptive terms, which doesn't help people who have the diagnosis sometimes - i.e.: "I am so depressed." vs. being diagnosed with major depressive illness.

 

In terms of personal stress, I think there is a lot of bias against psychiatrists, even in your colleagues and depending on your background, your family. My family still considers psychiatry "not real medicine" and berate me about wasting my MD to go do something that isn't "really medicine" - (real medicine to them means internal medicine or surgery; obs/gyn is acceptable).

 

I also feel that there is stigma against people who do psychiatry as work. Either we're villains or heroes in the media - you see it all the time; just pull up any CBC article and it's like - OMG the psychiatrists were SO MEAN and didn't admit my POOR SUFFERING FAMILY MEMBER - and reading things like that all the time makes me want to rip out my hair. People aren't armchair cardiologists. Why should they be armchair psychiatrists?

 

I think I burn through friends and partners really quickly too because of my work. I do carry a lot of it home with me, even though I try not to. There are a lot of frustrations in my work that does seep home... It's hard to limit it sometimes. Sometimes your patients don't have boundaries either - and it's hard to be on a date when your patient screams at you from the street and pounds on the glass window yelling HELLOOOOOO!!!! I SEEE YOUUUUUU!!!!! ... In my R1 year, I didn't mind running into patients from internal med and things because they'd usually say something complimentary or polite - "Thank you for looking after my wife in the ER, you did a really great job!" - and that makes you feel like a million dollars!!! Having your date say - "Is that the type of patient you see?" When someone is pounding on the glass and waving frantically for you to wave back doesn't quite leave you with the same feelings.

 

Don't get me wrong. I love my job. I love my colleagues. I love going to work every day, but there are definitely burdens in psychiatry that other specialties don't carry.

[LittleDaisy]

Thank you so much Renin for your input !

 

I suppose I can only speak from my personal experience. There's work stressors and then there's personal stressors... I'll address one at a time.

 

Work stress is like what Ellorie alluded to. Sometimes we just don't have anything to give, but we're asked to provide things, and we want to. Sometimes we're asked for things, but we can't give them for a therapeutic good. Sometimes families or other professionals demand things and we can't give them for therapeutic good, but others do not understand. Doing psychoeducation at 2 am, despite your best efforts, sometimes does not go well. My colleagues are extremely supportive and the faculty and staff are amazing. This helps against burnout, but there's something very lonely when the other services aren't supportive and you are the person kind of fielding the work issues.

 

I can't get into details because it's a public forum (obviously), but some days, despite our "shorter work hours" you leave bagged. I haven't been physically assaulted, but I have been verbally threatened by patients and families. Security is always available for an escort to your car. I don't really get these "shorter hours" either - I send the medical students home a lot sooner than I personally go home to slog through paperwork, and make phone calls, obtain collateral, talk to patients, talk to family, talk to other service providers in hospital and out ... so maybe that's the perception we work fewer hours? As for the slower pace, don't forget that when we interview a patient for 45 minutes, we're getting a lot of information. You're not a walking and talking list of memorized questions. There are many nuances to the psychiatric interview and treatment. You're thinking all the time - it might look quiet. It's like the swan on the lake; it looks calm, but under the water they're paddling away like crazy!

 

There's a meme thing going around describing people's attitude towards mental illness vs. medical illness. I think someone who is having a heart attack is told to think happy thoughts or something. The degree of impairment between mild, moderate and severe mental illness is such a great scale that I don't think laypeople realize it. Also, a lot of people use mental health terms as descriptive terms, which doesn't help people who have the diagnosis sometimes - i.e.: "I am so depressed." vs. being diagnosed with major depressive illness.

 

In terms of personal stress, I think there is a lot of bias against psychiatrists, even in your colleagues and depending on your background, your family. My family still considers psychiatry "not real medicine" and berate me about wasting my MD to go do something that isn't "really medicine" - (real medicine to them means internal medicine or surgery; obs/gyn is acceptable).

 

I also feel that there is stigma against people who do psychiatry as work. Either we're villains or heroes in the media - you see it all the time; just pull up any CBC article and it's like - OMG the psychiatrists were SO MEAN and didn't admit my POOR SUFFERING FAMILY MEMBER - and reading things like that all the time makes me want to rip out my hair. People aren't armchair cardiologists. Why should they be armchair psychiatrists?

 

I think I burn through friends and partners really quickly too because of my work. I do carry a lot of it home with me, even though I try not to. There are a lot of frustrations in my work that does seep home... It's hard to limit it sometimes. Sometimes your patients don't have boundaries either - and it's hard to be on a date when your patient screams at you from the street and pounds on the glass window yelling HELLOOOOOO!!!! I SEEE YOUUUUUU!!!!! ... In my R1 year, I didn't mind running into patients from internal med and things because they'd usually say something complimentary or polite - "Thank you for looking after my wife in the ER, you did a really great job!" - and that makes you feel like a million dollars!!! Having your date say - "Is that the type of patient you see?" When someone is pounding on the glass and waving frantically for you to wave back doesn't quite leave you with the same feelings.

 

Don't get me wrong. I love my job. I love my colleagues. I love going to work every day, but there are definitely burdens in psychiatry that other specialties don't carry.

[carazadie]

Thank you Renin for your insight. You've given us a lot to think about. I personally feel like each specialty has unique challenges, and psych is no different. Maybe some people are more suited to the challenges of one discipline than of another, and that's part of how we figure out where we belong.

[5th time the charm]

I think burnout can occur in any field of medicine and I think what is most important is achieving a work-life balance that works for you. Having said that, I think there are important practice characteristics and aspects of practice out of your control that can contribute to the feeling of burnout........

 

If you decide on a solo practice rather than working with a group of consulting psychiatrists in Private Practice or with a mental health clinic or based in a hospital setting, you may find you are quickly on the burn out pace.

 

I think in part because of isolation, the type of patients you may have (some are very dependent; freq. in crisis) and the high number of referrals you may get because everywhere is so under serviced for psychiatry that the minute a new psychiatrist comes to town, the referrals just keep coming. I think in a more organized clinic setting there is more of an opportunity to collaborate with other clinicians so you don't feel you have to wear many hats apart from your MD one.

I think its also important to make connections with other psychiatrists who may be in a similar situation as you in another community for example.(keep track where your resident friends go!!) Journal clubs seem to be popular but hard to sometimes organize (i.e. meeting once a month even if its to review cases)

 

I think though, the trade off to this is that management may make decisions that directly impact on your practice but you have not been given the opportunity for any important input.

 

I also think what contributes to burn out are the following: stigma; access to medication for patients being a problem (i.e. patients with no drug coverage); access to evidenced based psychotherapy the patient can't afford; no shows which you can't really recoup from the patient (many of these are hard to serve patients on disability pensions) which affects your ability to make a living; realizing despite the advances made in psychiatric care, there will be patients who won't get better and as hard as you may try this is the reality for some of them (especially those with a chronic disease/chronic pain and depression for example); perhaps having really high expectations of yourself that may not be realistic or families/patients placing high expectations on you to get the patient better. The patients are becoming much more complex and this can present some challenges.

 

You also need to make sure there is some provision for sessional funding to support the non-direct work you do if you are not salaried. In this economic environment, I would suggest not counting on big fee for service increases with the upcoming agreements that some provinces are involved with at this time.

 

If I were a resident, I would try to get experience in shared-care; subspecialty clinics such as first episode for psychosis or mood/anxiety; mood disorders; psychotherapy; sleep clinics. If you see yourself working more in an in-pt setting gain as much experience as you can at different hospitals as they may run their units differently. I think the more prepared you can be coming out of residency the better you will be able to handle the clinical pressures that come with working in this field no matter where you end up working.

 

I would also look to having some staff members as mentors for you as an early career psychiatrist, you may have a lot of questions when you first start out and don't be afraid to ask. Ask also about how to bill to maximize your income and don't be shy about this. You may also consider joining the APA and CPA as they have some important early career programs and I find they have a lot of useful information for day to day practice.

 

I think a varied practice is also helpful. I do consulting with family doctors in addition to having some psychotherapy patients. There is also the opportunity to work in student health settings; chronic pain clinics etc;

 

feel free to PM me if you'd like more info

 

Congrats to all the PGY-5's who officially graduate today and to all the PGY1'

s that are set to embark on their new careers tomorrow.

[NLengr]

I like how the psych people here are writing huge posts, true to psych form.

[5th time the charm]

I like how the psych people here are writing huge posts, true to psych form.

 

True to psych form

 

I didn't mean to be so long winded but any advice to help out my current and future colleagues I hope is somewhat helpful. There was lots I wish I knew during residency and in the first years of my career so my comments are a culmination of my experiences and thoughts about practice

[rmorelan]

True to psych form

 

I didn't mean to be so long winded but any advice to help out my current and future colleagues I hope is somewhat helpful. There was lots I wish I knew during residency and in the first years of my career so my comments are a culmination of my experiences and thoughts about practice

 

don't apologize for being helpful and if this actually a manifestation of being a skill psychiatrist resident then don't apologize for that either.

 

In turn I won't apologize for being infinitely excited about subtle shades of grey in dark rooms, solving puzzles and how anatomy is just the most amazing thing

[carazadie]

True to psych form

 

I didn't mean to be so long winded but any advice to help out my current and future colleagues I hope is somewhat helpful. There was lots I wish I knew during residency and in the first years of my career so my comments are a culmination of my experiences and thoughts about practice

 

And it really is appreciated! Thank you so much! It's not often that trainees get to have candid conversations with staff about issues like this. I found your advice very interesting.

[Renin]

True to psych form

 

I didn't mean to be so long winded but any advice to help out my current and future colleagues I hope is somewhat helpful. There was lots I wish I knew during residency and in the first years of my career so my comments are a culmination of my experiences and thoughts about practice

 

Thanks for all your kind thoughts I'm lucky that my staff are all very wonderful and my assigned mentor is able to advise me on the professional, business and personal sides of psychiatry.

 

*wheeeee*

[5th time the charm]

don't apologize for being helpful and if this actually a manifestation of being a skill psychiatrist resident then don't apologize for that either.

 

In turn I won't apologize for being infinitely excited about subtle shades of grey in dark rooms, solving puzzles and how anatomy is just the most amazing thing

 

and congrats on moving on to PGY 2!

[5th time the charm]

Thanks for all your kind thoughts I'm lucky that my staff are all very wonderful and my assigned mentor is able to advise me on the professional, business and personal sides of psychiatry.

 

*wheeeee*

 

Totally wish I had that when I was going through my program.

[Renin]

Totally wish I had that when I was going through my program.

 

Aww ... it definitely makes all things easier, knowing that they have your back and there's someone to go and talk to.

 

I don't think there's anyone in my year who is thinking of going into solo practice. The idea of that just scares me.

[rmorelan]

Aww ... it definitely makes all things easier, knowing that they have your back and there's someone to go and talk to.

 

I don't think there's anyone in my year who is thinking of going into solo practice. The idea of that just scares me.

 

programs without mentorship don't make much sense to me - the entire residency set up is very "master and apprentice" style old world education system and that really only works with well mentorship - it is kind of the point. We have that at Ottawa as well for rads and it is extremely helpful.

[Renin]

programs without mentorship don't make much sense to me - the entire residency set up is very "master and apprentice" style old world education system and that really only works with well mentorship - it is kind of the point. We have that at Ottawa as well for rads and it is extremely helpful.

 

Hopefully not in the Greek style

[rmorelan]

Hopefully not in the Greek style

 

well not that old - Although the Socratic method still gets thrown around a lot

[Renin]

well not that old - Although the Socratic method still gets thrown around a lot

 

It's true, that's how I teach ... usually ... and kinda how we do certain types of therapy!